Health Capital Topics 2012

The healthcare industry landscape, historically subject to constant change, is now increasingly becoming an unpredictable environment of new provider structures, strategies and tactics. New forms of alignment and integration have arisen within an accelerating pace of transactions involving the acquisition of physician practices (or specific assets of those practices) and the subsequent employment of the selling physicians by the acquiring hospitals. The perceived volatility of this pattern of change is driven, in part, by the growing concern over rising healthcare costs; the current economic environment of slowed growth; high unemployment; and, record federal deficits and debt, resulting in a perfect storm and catalyst for change. In developing an understanding of the forces and stakeholders that have the potential to drive healthcare markets, it is useful to examine what value may be attributable to healthcare enterprises, assets and services as they relate to the Four Pillars of the healthcare industry, i.e., regulatory, reimbursement, technology, and competition . Health Capital Topics is a monthly newsletter which has been published by Health Capital Consultants since 2007, featuring timely topics related to the regulatory, reimbursement, competition, and technology aspects of the U.S. healthcare delivery environment. It is sent to over 12,000 healthcare executives, physicians, attorneys, accountants, and other professionals in the healthcare industry. Copies of past monthly issues and special alert issues can be found at This book is a compilation of excerpts originally published in the newsletter, HC Topics, which have been organized by topic in relation to the Four Pillars concept. The intent of this book is that it will serve as an (admittedly abridged) brief primer and reference source for these issues.


Table of Contents



Accountable Care Organizations Series

Healthcare Reform's Tax Provisions Strain IRS Resources

Medicare Advantage Plans Squeezed in 2012 Under Healthcare Reform's

Tax Provisions Strain IRS Resources

Dealing with the Medicare Doughnut Hole

Medical Loss Ratio Final Rule Divides Consumers and Insurers

What the New Form 990 Means for Exempt Organizations

HHS Releases Final Rule on State Health Insurance Exchanges

Individual Insurance Under Healthcare Reform: A Boon for Policyholders

SCOTUS Upholds Health Law - What Happens Next?

Federal Fraud Task Force Has Largest Takedown to Date

Statutory Elimination of Physician-Owned Hospital Exceptions

CMS Auditing Series

First Annual RAC Report: Missouri is the “Big Winner”

CMS Continues Self-Referral Disclosure (SRDP) Settlements

Auditing Programs: Back to the Drawing Board?

Public Health Series

Medicaid Expansion: A Fiscal Decision to Ensure Access to Care

AHRQ Quality Indicators Toolkit Offers Hospitals Implementation Guidance

Preventive Care: What is an Ounce Really Worth? 

New IOM Report Calls for Better Learning and Adoption 


Vermont Adopts Single-Payor System

CMS Bundled Payments Initiative: Four Models for Coordinated Care

CMS Bars Medicaid Payments for Preventable Conditions

Value-Based Modifier: Another Step Toward Value-Driven Healthcare

Better Patient Outcomes Through Pay-for-Performance


Insurer-Run Care Expanding into Retail Clinics

Capital Spending in the Current Healthcare Environment

Provider Supply Series

Update on Pediatrics

Shared Decision Making: A Step Toward Patient-Centered Care


CMS Finalizes Rule on Telemedicine

The Expense of the ICD-10 Conversion

HIPAA Version 5010: What and When

Whistling Past the Graveyard Series

Stage 2 Meaningful Use: What’s Coming Down the Pike


Firm Background

HCC Leadership Team

Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA

Todd A. Zigrang, MBA, MHA, FACHE, ASA

Anne P. Sharamitaro, Esq.